Airway Flashcards
Motor innervation of the airway?
… innervate cricothyroid muscle which it function as ….
And this only nerve …. innervates all other internsic muscles of larynx
SUPERIOR laryngeal N, EXTERNAL branch
It tensing of vocal cords and constricts the inferior pharyngeal
Recurrent laryngeal (CN X or vagus) supplies all other internsic muscles of larynx
Superior laryngeal nerve, external branch (CN X/vagus innervates …. for motor and provide sensory to ….
Cricothyroid muscle
EXTERNAL = ex cersise (motor)
Anterior subglotic mucosa
Recurrent laryngeal N supplies all internsic laryngeal muscles (except cricothyroid) and provides sensory to … and ….
Subglottic mucosa
Muscle spindles
What sensory innervation for larynx above vocal cord
Superior laryngeal, INTERNAL INTERNAL INTERNAL branch
INTERNAL = sensory
Endo bronchial intubation effects
Reduced respiratory reserve
Barotruma in long-standing ventilation
Hemothorax and pneumothorax
Mnemonic for which internal or external laryngeal nerve supplies motor or sensory SIME
S sensory I internal
M motor E external
Peds vs adult of larynx
peds higher up in neck
Larynx level C3-4 in peds and C4-5 in adults
Cricoid ring is the narrowest
Laryngeal spasm afferent innervation?
Superior internal laryngeal nerve
In FOI awake blocking 3 sites;
Transtracheal block hits which nerve
Recurrent laryngeal
Awake FOI 3 blocks locations;
Ant tonsilar pillar (at base) ….
Tonsils to block CN9 (only the brach supplying tonsils, lingual, and pharyngeal branches)
Awake FOI 3 blocks locations;
Inf to greater Cornu of hyoid bone …
Block the internal branch is superior laryngeal N
Innervation
Anterior tongue->
Post tongue, soft palate and oropharynx ->
Hypopharynx (the oropharynx below epiglottis) ->
Vocal cord ->
Larynx and trachea ->
V3 trigeminal
lX
Internal of sup laryngeal (vagus)
Vocals -> internal sup laryngeal + recurrent laryngeal (vagus)
Recurrent laryngeal (X) for below vocals
Patient not tolerating FOI after bronchoscope passes epiglottis but before vocal cords, what block you need?
This is a block needed in hypopharynx area (area between epiglottis and vocals)
Innervated by Internal branch of sup laryngeal N (branch of vagus)
Done by injecting into inferior aspect of greater Cornu of the hyoid bone b/l
Why don’t you block the recurrent laryngeal N alongside the treachea instead of transtracheal?
Blocking recurrent unilateral causes hoarseness from partial vocal cord addiction
Stridor and airway obstruction occurs with b/l percatenous recurrent laryngeal N block due to complete vocal addiction
There is only one muscle that aBductor of vocal cord?
Posterior cricoarytenoid
P with aBd
Adductors are the left muscles (transvers and lateral arytenoid)
If you have patient with hoarseness and you see partial vocal cord abduction ipsilateral in aortic disease or surgery as well as left main bronchus or plum artery. What explains that?
Left recurrent N could be injured ( loses the abd and add of vocal but not the tenders which is the cricothyroid ms)
The left recurrent courses under the aortic arch before supplies glottis and can be affect by expanding thoracic aortic aneurysms for example.
Most sensitive PE indicator for difficult intubation?
Mallampati
Second is thyromental distance
The least specific indicator for difficult airway?
Mallampati (it is the most sensitive but most likely to incorrectly identify nondoficult airways as difficult airway)
The most specific; thyromental > movement of neck > mouth opening
2 axis are paralllel in sniffing neck?
Pharynx and Laryngeal especially when rising occipital head relative to shoulder
Maximum parallel of these 2 axis by neck extension
The narrowest airway opening I’m adults?
Glottic
Neonates -> cricoid cartilage
Pneumocyte 1 primarily involved in …. and type 2 in ….
Gas exchange
Type 2 for surfactant production
2 bad things in lung volume
Increasing closing lung capacity and decreasing FRC
Things increases or decreases both is important to know
Increases closing capacity mnemonic (ACLS-S; … surgery and smoking
Sensory innervation of the lung is … and its function is …
Vagus (all sensation below vocal cord by vagus) and it supplies the PSNS which causes bronchioconstriction and bronchial secretion.
Cardioaccelerators originates from … and go through … before it reaches
T1-4 sympathetic, go through stellate ganglion before reaches the heart
SNS of the lungs originates from … and causes …
T1-4, bronchioDilation when stimulated.
Dose cricoid pressure increase or decrease risk of aspiration?
Although routinely used to decrease risk for aspiration, recent evidence suggests cricoid pressure may actually increase the risk for reflux in anesthetized patients. Cricoid pressure decreases LES tone without influencing gastric pressure. This leads to a decreased barrier pressure and therefore potentially increases the risk of aspiration. The clinical significance of this, however, has not been determined. Opponents of cricoid pressure affirm that succinylcholine increases LES tone, making the need for cricoid pressure during rapid sequence induction (RSI) questionable. Cricoid pressure continues, however, to be the standard of care during RSI.
The glossopharyngeal nerve is blocked at the …
at the palatoglossal folds.
The recurrent laryngeal nerve can be blocked with …
a transtracheal injection through the cricothyroid membrane.
The superior laryngeal nerve can be blocked by …
either injection at the horn of the hyoid bone or by placing a pledget in the pyriform sinus.
